Amid the fingerpointing, state lawmakers in Georgia have largely homed in on regulating pharmacy benefit managers’ practices and boosting cost transparency through several bills over the last few years. Since 2019, several state bills have been signed into law to block pharmacy benefit managers from directing patients to certain pharmacies over others and give health plans access to a larger share of drug discounts, called rebates.

State lawmakers also passed recent legislation to disclose what rebates pharmacy benefit managers have collected and to create a new database to track payments for many health services, including prescription drugs filled under private health plans. That process is in the early stages of being set up through the newly created state Office of Health Strategy and Coordination, said a spokesman with Gov. Brian Kemp’s office.

Without more data on medication prices and costs in Georgia, some state lawmakers say it’s tough to craft legislation that can tackle costs for specific drugs that many Georgia residents need – even though they believe the recent bills have made strides in cost transparency.

“This whole game is like whack-a-mole,” said state Rep. David Knight, a Republican from Spalding County who has sponsored several medication-focused bills. “You think you’ve solved one problem and something else pops up.”

Legislation isn’t the only tool that state officials have tapped recently to start pulling back the curtain on how much drugs cost in Georgia. Over the past two years, a law firm from Mississippi has been digging into prescription drug data for Georgia’s Medicaid programs and the health plan for state employees, according to a document State Affairs obtained in an open-records request.

Representatives from the firm, Liston & Deas LLC, declined to give details on what they’re investigating in Georgia – though the firm has been conducting probes in several other states into the practices of a company that also manages one of Georgia’s Medicaid programs.

Just this year, the firm secured a $55.5 million settlement in Mississippi and an $88.3 million settlement in Ohio from that company, Centene Corporation, to cover large Medicaid costs in those states. One of the firms’ attorneys did tell State Affairs that they are pursuing similar litigation in Oklahoma, Kansas, Arkansas and Texas. State records show several pharmacy benefit managers have reimbursed local pharmacies less on average than they charge Georgia’s Medicaid programs for prescription drugs – a difference of roughly $89 million from July 2017 to July 2019.

Georgia Attorney General Chris Carr also last month joined several state attorneys general to back North Dakota health officials in a lawsuit brought by the pharmacy benefit managers’ association, which seeks to overturn that state’s regulations on many of their practices. The outcome of that lawsuit could set the tone for possible legal challenges to Georgia’s recently enacted rules on pharmacy benefit managers going forward.

Ultimately, patient advocates stress it’s the millions of Georgia residents reliant on prescription drugs who suffer no matter which party deserves the most blame between pharmacy benefits managers, drugmakers, local pharmacies and a host of other players. For seniors like Roetger, a future in which their medications become affordable can seem like wishful thinking. Still, Roetger holds out hope he’ll one day have easier access to his inhaler – though, for now, it’s a slim hope. 

“Who knows? Maybe in 10 years, things will be different,” Roetger said. “But in 10 years, I may be gone.”

What else would you like to know about prescription drugs in Georgia and the state’s health care system? Share your thoughts/tips by emailing [email protected].